Urologic Oncology-seminars and Original Investigations最新文献

{"title":"ANALYSIS OF THE INCREASED INCIDENCE OF AGGRESSIVE PROSTATE CANCER AFTER PRIOR TESTICULAR CANCER","authors":"Kevin Joseph Xu,&nbsp;Amir Khan,&nbsp;Minhaj Siddiqui","doi":"10.1016/j.urolonc.2024.12.101","DOIUrl":"10.1016/j.urolonc.2024.12.101","url":null,"abstract":"<div><h3>Introduction</h3><div>Some recent studies have suggested that testicular cancer survivors are at increased risk of developing aggressive prostate cancer compared to the general population while others have not found this link. The objective of this study is to determine if testicular cancer survivors are predisposed to higher incidence of aggressive prostate cancer later in life and greater risks of prostate cancer specific mortality.</div></div><div><h3>Methods</h3><div>This was a retrospective case-control study of patients who developed prostate cancer and who previously had either testicular cancer or a control group cancer greater than five years prior. We used the Surveillance, Epidemiology, and End Results (SEER) database to access national cancer patient data from 1975-2020 and identify if patients with a history of testicular cancer have an earlier development of more aggressive secondary prostate cancer with higher mortality compared to those in the control group. Due to the high 5-year relative survival of testicular cancer, the control group included breast, bladder, cranial nerves and nervous system (excluding the brain), eye/orbital, oral cavity, skin, renal, thyroid cancers. Patient morbidity and mortality was assessed using Gleason scores, PSA, tumor stage, and survival time and stratified into low, moderate, and high risk accordingly. Cox regression models were used to determine the risk of mortality.</div></div><div><h3>Results</h3><div>We identified that prostate cancer does occur globally more in patients with testicular cancer compared to controls. The mean age in years of prostate cancer diagnosis for the testicular cancer group was 61.62 +/- 7.88, while the control group was 66.66 +/- 8.8. By the age of 60, we found that 10.7% of patients in the testicular cancer group had developed prostate cancer, compared to 6.8% of the control group. Patients in the testicular cancer group saw a decreased survival time in months (105) compared to the control (136).</div></div><div><h3>Conclusions</h3><div>We determined that patients with a history of testicular cancer may be at an increased risk of developing prostate cancer earlier with a higher mortality rate compared to other cancer survivors. Confirmatory studies are warranted.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Pages 40-41"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"UTILITY OF TUMOR-INFORMED CIRCULATING TUMOR DNA (CTDNA) IN PATIENTS UNDERGOING RETROPERITONEAL LYMPH NODE DISSECTION FOR TESTICULAR CANCER","authors":"Reuben Ben-David,&nbsp;Reza Mehrazin,&nbsp;Neeraja Tillu,&nbsp;Sarah Lidagoster,&nbsp;Matthew Galsky,&nbsp;Che-Kai Tsao,&nbsp;Kyrollis Attalla,&nbsp;Peter Wiklund,&nbsp;John Sfakianos","doi":"10.1016/j.urolonc.2024.12.084","DOIUrl":"10.1016/j.urolonc.2024.12.084","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Circulating tumor DNA (ctDNA) has been gaining popularity in directing and tailoring treatment modalities in solid cancers. ctDNA utility before and after diagnosis of testicular cancer has not yet been well-characterized. We seek to characterize the utility of ctDNA in correlation with pathologic and clinical features in patients with testicular cancer who underwent retroperitoneal lymph node dissection (RPLND).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Our single institution prospectively maintained database identified consecutive patients who underwent radical orchiectomy for germ cell tumor (GCT) between 2021 - 2023, included were patients who had prospectively collected ctDNA (Signatera&lt;sup&gt;TM&lt;/sup&gt;) analyses performed before and after RPLND. ctDNA signature was informed from the radical orchiectomy specimen in 9 patients and from the RPLND specimen in 8 patients (Figure 1). The informed signature was used throughout the patient's surveillance. Pre-RPLND ctDNA status was determined from blood drawn prior to surgery, and the post-RPLND minimal residual disease (MRD) window ctDNA status was determined from blood drawn after and within 90 days from RPLND. Study findings were reported using descriptive statistics. R programming language version 4.3.1 was used for all statistical analyses.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Seventeen patients had 89 ctDNA analyses performed before and after RPLND. The median age was 31 (IQR 25-33). The median follow-up time was 11 months (IQR 7-13). The primary testicular pathology prior to RPLND was non-seminoma for 14 patients (82.3%), seminoma for 2 patients (11.7%), and one patient had primary retroperitoneal seminoma (5.8%). Nine patients underwent primary RPLND (53%), 6 underwent post-chemotherapy RPLND (PS-RPLND, 35%) and 2 patients had RPLND performed due to recurrence while on surveillance for clinical stage I (11.7%). Serum tumor markers (STM) were normal for all the patients prior to RPLND. Pre-RPLND ctDNA status was available for 13 patients, ctDNA was undetectable in 8 patients (5 had benign pathology and 3 had teratoma), and detectable in 5 patients (38%); among them, 4 had viable GCT and one had teratoma. Fourteen patients had ctDNA MRD window status available. Four had detectable ctDNA status (28.5), all of them had disease progression (100%) and received further chemotherapy after RPLND. Only 1 of the 4 patients had elevated STM after RPLND (25%). Ten patients (71.4%) had undetectable MRD ctDNA status, 9 patients (90%) are currently under surveillance without evidence of disease recurrence, and one patient received adjuvant chemotherapy after RPLND without evidence of disease recurrence, all had post-RPLND normal STM. Detectable pre-RPLND ctDNA signature was found only in 1 of 4 patients with teratoma on RPLND histology (25%).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Detectable ctDNA status in the pre-RPLND status was associated with viable GCT on histology while havin","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 33"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"WHAT CLINICAL FACTORS PREDICT OUTCOMES IN RECURRENT METASTATIC CASTRATE-SENSITIVE PROSTATE CANCER? RESULTS FROM THE SEARCH DATABASE","authors":"John Heard,&nbsp;Galen Cook-Weins,&nbsp;Martha K. Terris MD, FACS,&nbsp;Zach Klaassen MD,&nbsp;Christopher J. Kane MD,&nbsp;Lourdes Guerrios Rivera MD,&nbsp;Matthew R. Cooperberg MD, MPH,&nbsp;William J. Aronson MD,&nbsp;Christopher L. Amling MD, FACS,&nbsp;Stephen J. Freedland MD","doi":"10.1016/j.urolonc.2024.12.064","DOIUrl":"10.1016/j.urolonc.2024.12.064","url":null,"abstract":"<div><h3>Introduction</h3><div>Approximately one third of patients with prostate cancer (PC) undergoing radical prostatectomy (RP) develop biochemical recurrence within 10 years. PC in these men is heterogenous, with most following an indolent course, however up to one third will progress to metastatic castrate sensitive disease (mCSPC). Patient and clinical factors associated with progression from non-metastatic PSA recurrence to mCRPC or death include increased age, shorter time from surgery to recurrence, higher Gleason grade (PC specific tumor grade), and shorter PSA doubling time (PSADT). The factors that influence disease progression once patients develop mCSPC are unknown.</div></div><div><h3>Methods</h3><div>After obtaining IRB approval, the SEARCH database was created by combining data on 9,928 patients who underwent RP from 1982 to 2020 at eight VA Medical Centers across the U.S. Patients with recurrent mCSPC after RP were selected for analysis. Those treated with preoperative ADT or radiation therapy were excluded, as were patients who developed CRPC prior to metastasis. Patients who received ADT more than 3 months prior to metastasis were excluded. Of the 278 men who met these criteria, 153 were excluded due to missing data. We used multivariable cox proportional hazards regression modeling to assess the association between clinical variables at the time of mCSPC and the primary outcome of overall mortality (OM).</div></div><div><h3>Results</h3><div>Of 125 patients with recurrent mCSPC, median age at metastasis was 70. Median time from surgery to metastasis was 61 months. During follow-up, 60 patients (48%) progressed to mCRPC while 56 (45%) died from PC and 81 (65%) died from any cause. Shorter PSADT was the only clinical or pathologic feature associated with progression to OM (HR = 0.98, p &lt; 0.0001). Patients were divided into groups based on PSADT widely used in non-metastatic biochemical recurrence (&lt;3, 3-8.9, &gt;9 months). On multivariable analysis, PSADT &lt;3 months and 3-8.9 months were associated with worse overall survival (OS) than PSADT &gt;9 months (Table 1). Median time to OS and 5-year OS rates were 93 months and 64% for PSADT &gt;9 months, 47 months and 41% for 3-8.9 months, and 25 months and 12% for &lt;3 months.</div></div><div><h3>Conclusions</h3><div>Outcomes for patients with recurrent mCSPC after RP were driven primarily by PSADT rather than other clinical features, including Gleason score. Our data demonstrates that patients with PSADT &lt; 9 months have rapidly progressive disease that warrants aggressive treatment and inclusion in clnical trials. In contrast, those with PSADT &gt; 9 months have a more indolent course despite the presence of metastases and may be candidates for deintensificaiton strategies.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Pages 25-26"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"QUALITY OF LIFE, DECISIONAL REGRET, AND FEAR OF RECURRENCE IN PATIENTS WITH MUSCLE-INVASIVE BLADDER CANCER MANAGED WITH SURVEILLANCE AFTER CLINICAL COMPLETE RESPONSE TO NEOADJUVANT CHEMOTHERAPY","authors":"Niccola B. Lynch,&nbsp;Emily Neckonoff,&nbsp;Ketty Bai,&nbsp;Caroline Laplaca,&nbsp;Srinath-Reddi Pingle,&nbsp;Benjamin I. Joffe,&nbsp;Karie D. Runcie,&nbsp;Alexander Z. Wei,&nbsp;Mark N. Stein,&nbsp;G. Joel Decastro,&nbsp;Christopher B. Anderson,&nbsp;James M. McKiernan,&nbsp;Andrew T. Lenis","doi":"10.1016/j.urolonc.2024.12.041","DOIUrl":"10.1016/j.urolonc.2024.12.041","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;While the standard-of-care for muscle-invasive bladder cancer (MIBC) includes radical cystectomy (RC) and urinary diversion, many patients are unfit or unwilling to undergo major surgery and instead opt for a bladder-sparing approach. Data regarding the safety and durability of surveillance in patients who achieve a clinical complete response (cCR) to neoadjuvant chemotherapy (NAC) is accumulating and encouraging. Despite this increasing interest from both patients and clinicians, there is limited data on the quality of life of cCR patients. In this study, we surveyed patients in our prospectively maintained clinical database who achieved cCR and were managed primarily with surveillance.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We contacted all patients from our prospectively maintained cCR database for enrollment in our study. Consenting participants were emailed via Docusign three validated quality of life surveys, including the Bladder Cancer Index (BCI), the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF), and the Decision Regret Scale. These surveys evaluate urinary function, bowel habits, sexual function, fear of cancer recurrence, and decisional regret. Survey responses were recorded in REDCap under a de-identified profile. Survey data was analyzed using descriptive statistics.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;From a total of 61 patients in the cCR database, 33 patients were alive and available to participate. To date, 19 (58%) patients have completed the surveys. Patient demographics and disease characteristics are presented in Table 1. Of the 19 participants, 79% (15/19) had a native bladder, 5% (1/19) had a neobladder, 5% (1/19) had a continent catheterizable pouch, and 11% (2/19) had an ileal conduit. Of the cCR patients with durable response, 100% (15/15) had no decisional regret and 67% (10/15) had little to no fear of cancer recurrence. Conversely, in cCR patients with recurrence and subsequent RC, 25% (1/4) had significant decisional regret and 75% (3/4) had some fear of cancer recurrence. Of the durable response cCR patients, 93% (14/15) had no urinary bother while 50% (2/4) of the recurrence and subsequent RC patients had some urinary bother.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;As surveillance in patients with MIBC who achieve cCR after NAC becomes increasingly utilized, data on the implications of lifelong surveillance, frequent non-invasive recurrences, and the fear of cancer recurrence will be important to consider. In the data available at this time from our institutional cCR cohort, all patients with a durable response were free of decisional regret, nearly all (93%) had no urinary bother despite frequent interventions, and two thirds lacked fear of cancer recurrence. Study limitations include small sample size, response and selection bias given the survey format, and limited generalizability given patients were recruited from a single institution. Nevertheless, these results sugg","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 16"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"M2-LIKE POLARIZED TAMS SIGNATURE DEFINED BY SCRNA: IMPLICATIONS FOR POOR PROGNOSIS IN BLADDER CANCER AND CONSTRUCTION OF A PROGNOSTIC MODEL BASED ON M2-LIKE GENES","authors":"Eran Maina,&nbsp;Betty Wang,&nbsp;Christopher Weight,&nbsp;Nima Almassi,&nbsp;Samuel Haywood,&nbsp;Robert Abouassaly,&nbsp;Phillip Abbosh,&nbsp;Rebecca Campbell,&nbsp;Laura Bukavina","doi":"10.1016/j.urolonc.2024.12.044","DOIUrl":"10.1016/j.urolonc.2024.12.044","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Bladder cancer (BCa) is among the most common malignancies worldwide and overall survival (OS) remains poor despite treatment advances. Tumor-associated macrophages (TAMs) are monocyte-derived cells that invade the BCa tumor microenvironment (TME) and display a range of functional pro-tumor and anti-tumor phenotypes dependent on distinct environmental factors and stimuli. Specifically, TAMs polarized toward M2-like states are associated with angiogenesis, immunosuppression, and metastasis. Despite this knowledge, the impact of M2-like subsets on BCa prognosis remains largely unexplored partly due to nonspecific transcriptomic signatures hindering identification. Single-cell (scRNA) sequencing technology has transformed our understanding of functional diversity at the single-cell level in multiple cancers. In this study, we harnessed scRNA data from bladder tumor patients and characterized a polarized M2-like gene signature to explore the association of M2-like TAMs with OS in BCa. We then constructed a prognostic risk model based on M2-like gene signatures to identify biomarkers predictive of poor prognosis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The scRNA data of 15 BCa patients were collected and analyzed (Seurat R package, v5.0.1). Samples were from the NCBI Gene expression Omnibus and collaborators. Seurat objects were created, merged, and normalized as a single dataset (Seurat v5 integration pipeline). We identified the M2-like gene cluster based on canonical markers in the literature. Strict criteria were used to define the M2-like cluster and M2-like associate genes (|logFC|&gt;3.0, &lt;em&gt;p&lt;/em&gt;&lt;0.05). EnrichR database was used to functionally characterize the M2-like cluster. Infiltration levels of M2-like gene signatures in individual samples were estimated with single-sample Gene Set Enrichment Analysis. To construct a prognostic risk score based on M2-like TAMs, we used M2-like differentially expressed genes as candidate genes to explore those significantly associated with BCa prognosis. We integrated survival event and OS time with LASSO Cox regression model to find survival-related genes and form the prognostic model and risk score.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The scRNA sequencing data of 15 BCa samples yielded 46,968 cells for further analysis after quality control and batch-effect correction. We identified 34 clusters and further annotated these 34 clusters into three major categories, keeping the M2-like cluster intact for simpler visualization (Figure 1). We selected 79 genes identified from the M2-like TAMs cluster from scRNA and used them as candidate genes to construct the prognostic risk model. LASSO Cox regression obtained nine key prognostic genes that had the highest impact on OS [&lt;em&gt;RGS2&lt;/em&gt; (coef= 0.105918), &lt;em&gt;CCL3L3&lt;/em&gt; (coef= -0.000413), &lt;em&gt;CXCL14&lt;/em&gt; (coef= 0.006135), &lt;em&gt;AMICA1&lt;/em&gt; (coef= -0.084312), &lt;em&gt;SPP1&lt;/em&gt; (coef= 0.007112), &lt;em&gt;CPVL&lt;/em&gt; (coef= 0.054197), &lt;em&gt;EMP","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 17"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HOSPITAL OUTCOMES AND HEALTHCARE BURDEN OF TESTICULAR CANCER: A RETROSPECTIVE ANALYSIS OF THE 2024 NATIONAL INPATIENT SAMPLE","authors":"Srinishant Rajarajan,&nbsp;Kalaivani Babu,&nbsp;Sruthi Ramanan,&nbsp;Nithya Ramesh,&nbsp;Asmi Chattaraj,&nbsp;Amit Correa","doi":"10.1016/j.urolonc.2024.12.090","DOIUrl":"10.1016/j.urolonc.2024.12.090","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Testicular cancer, although relatively rare, is the most common malignancy in young men aged 15 to 35 years. It accounts for approximately 1% of all male cancers but has a high survival rate if detected early. Testicular cancer can have significant implications for fertility and quality of life, making it a critical area of focus for public health and clinical research. Despite advancements in treatment, disparities in outcomes exist based on various demographic and hospital-related factors. This study aims to estimate the prevalence, mortality rate, hospital length of stay (LOS), and total hospitalization charges for patients with testicular cancer using the National Inpatient Sample (NIS) data from 2021.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a retrospective analysis using the NIS dataset, which included 6,666,752 observations. Testicular cancer cases were identified using the appropriate ICD-10 code. Survey procedures (svy) were utilized to account for the complex survey design of the NIS. The primary outcome of interest was in-hospital mortality, while secondary outcomes included hospital length of stay (LOS) and total hospitalization charges (TOTCHG). Descriptive statistics and regression analyses were performed to examine the associations between testicular cancer and these outcomes. Independent variables included age, gender, race, zip code income quartile, Charlson Comorbidity Index, weekend admission, hospital region, teaching status, and bed size.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The total number of testicular cancer cases was estimated to be 8,225 (95% CI: 7,434 - 9,016). The crude total of in-hospital deaths among testicular cancer patients was 265 (95% CI: 192 - 338), resulting in a mortality rate of 3.22% (95% CI: 2.45% - 4.23%). Adjusted logistic regression analysis revealed significant associations with the Charlson Comorbidity Index (Odds Ratio [OR] = 1.390, p &lt; 0.001) and hospital teaching status (OR = 0.468, p = 0.043), while patients identified as Asian/Pacific Islander had a significantly higher odds ratio (OR = 6.210, p = 0.004).&lt;/div&gt;&lt;div&gt;The mean LOS for testicular cancer patients was 6.44 days (95% CI: 6.07 - 6.82). Adjusted linear regression analysis showed that LOS was significantly associated with patients identified as Native American (Coefficient = 14.039, p = 0.041) and Charlson Comorbidity Index (Coefficient = 0.590, p &lt; 0.001). The mean total hospitalization charges for testicular cancer patients were $88,194 (95% CI: $80,853 - $95,536). Adjusted regression analysis identified significant associations with Charlson Comorbidity Index (Coefficient = $8,633, p &lt; 0.001), hospital region, teaching status (Coefficient = $19,921, p = 0.006), and hospital bed size (Coefficient for the largest bed size category = $19,562, p = 0.009).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;This study highlights the significant burden of testicular cancer in hospitalized patients, with","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 36"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DO THE METASTATIC PATTERNS OF SEMINOMA SUPPORT PRIMARY RPLND AS THE TREATMENT OF CHOICE IN STAGE II SEMINOMA COMPARED TO NON-SEMINOMA?","authors":"Khalid Y. Alkhatib,&nbsp;Roby Daniel,&nbsp;Sydney Chambule,&nbsp;Avanti Rangnekar,&nbsp;Yash Shah,&nbsp;Morgan A. Leff,&nbsp;Madhumita Parmar,&nbsp;Trinity J. Bivalacqua,&nbsp;Daniel J. Lee,&nbsp;Thomas J. Guzzo,&nbsp;Phillip M. Pierorazio","doi":"10.1016/j.urolonc.2024.12.092","DOIUrl":"10.1016/j.urolonc.2024.12.092","url":null,"abstract":"<div><h3>Introduction</h3><div>Primary RPLND is one treatment modality for stage II seminoma germ cell tumor (SGCT) cases. In theory, the success of the procedure relies on having the disease confined within the dissected lymph nodes with no presence of any undetected organ metastatic disease outside the surgical margins. While SGCT characteristics and behavior have been well described in comparison to non-seminoma germ cell tumors (NSGCT), quantifying the probability and absolute causal effect of SGCT subtype in having advanced metastatic disease (i.e., Stage III) compared to NSGCT has not been described using large national dataset yet. Therefore, we aim to quantify and describe this relationship using the National Cancer Database (NCDB).</div></div><div><h3>Methods</h3><div>We utilized inverse propensity score weights (IPTW) calculated by age, primary tumor characteristics, patient sociodemographic, regional and facility level, and year of diagnosis to run a multivariable IPTW-weighted logistic regression model (MVA) for the outcome of stage III (vs. stage I/II) to estimate the odds ratio of SGCT presenting with stage III. Then, we utilized IPTW to estimate the absolute average causal effect of SGCT v.s. NSGCT in developing stage III in our balanced IPTW-matched study sample.</div></div><div><h3>Results</h3><div>We identified 62,329 testicular germ call cancer patients between 2004 and 2016 (details available in Table 1). Our IPTW-MVA showed that SGCT is significantly less likely to present with stage III disease compared to NSGCT after accounting for all available covariates (OR: 0.303, [95%CI; 0.278 – 0.330], p&lt;0.0001), based of the same model we estimated the mean causal effect of presenting as stage III to be significantly less likely in SGCT compared to NSGCT by 66.41% if all other patients parameters and variables were the same (- 62.41% [95%CI: - 65.00%, -59.82%], p&lt;0.0001).</div></div><div><h3>Conclusions</h3><div>Our results strongly validate the use of primary-RPLND in SGCT as opposed to NSGCT, as SGCT are 62.41% less likely to present with advanced stage given the same parameters in NSGCT. In addition torecent favorable clinical trial results, primary RPLND in carefully selected SGCT patients should be highly considered to avoid long-term complications associated with other treatment modalities.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Pages 36-37"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovative 3D method predicts surgery outcomes by calculating real contact surface of renal tumor","authors":"Paolo Traverso M.D., Ph.D. ,&nbsp;Alessandro Carfì Ph.D. ,&nbsp;Alessandra Bulanti M.Sc. ,&nbsp;Martina Fabbi M.D. ,&nbsp;Veronica Giasotto M.D. ,&nbsp;Matilde Mattiauda M.D. ,&nbsp;Lorenzo Lo Monaco M.D. ,&nbsp;Stefano Tappero M.D. ,&nbsp;Giovanni Guano M.D. ,&nbsp;Federica Balzarini M.D. ,&nbsp;Marco Borghesi M.D., Ph.D. ,&nbsp;Fulvio Mastrogiovanni Ph.D. ,&nbsp;Carlo Terrone M.D., Ph.D.","doi":"10.1016/j.urolonc.2024.10.021","DOIUrl":"10.1016/j.urolonc.2024.10.021","url":null,"abstract":"<div><h3>Objective</h3><div>The Contact Surface Area (CSA) is a predictor for peri-operative parameters and represents the contact area between the tumor and the organ. A precise method for calculating CSA is yet to be found. We tested a new CSA calculation method as a predictor of intra-operative parameters in robot assisted partial nephrectomy (RAPN).</div></div><div><h3>Materials &amp; Methods</h3><div>The study population consisted of all consecutive patients treated with RAPN at a single high-volume European institution (between 2020 to 2023; 82 patients). We proposed a new method to measure the real value of CSA using an algorithm that leverages the geometry of kidneys and tumors obtained from 3D reconstruction. These reconstructions were obtained using the certified software Materialized Mimics InPrint. The peri-operative parameters of patients were recorded in an anonymous database. We explored the correlation between real CSA (RCSA), CSA of Hsieh (HCSA), PADUA and R.E.N.A.L. scores with peri-operative parameters using Spearman's correlation. Furthermore, we examined which of RCSA, PADUA and R.E.N.A.L. score better describes the intra-operative parameters, Warm Ischemia Time (WIT), Operating Time (OT), and Estimated Blood Loss (EBL) using Receiver Operating Characteristic (ROC) curve analysis. Multivariable linear regression analyses were performed.</div></div><div><h3>Results</h3><div>Seventy-eight patients were prospectively enrolled. We observed a significant correlation between RCSA and WIT (<em>P &lt;</em> 0.001), OT (<em>P &lt;</em> 0.001) and EBL (<em>P &lt;</em> 0.001). Moreover, RCSA outperformed both the PADUA and R.E.N.A.L. score as demonstrated in the ROC curve analysis. In ROC analysis was chosen a threshold for each of the parameters: for WIT 20 minutes, for OT 180 minutes and for EBL 200 mL. At multivariable regression analysis, RCSA emerged as the only independent predictor for WIT (<em>P =</em> 0.002), OT (<em>P =</em> 0.01) and EBL (<em>P &lt;</em> 0.001).</div></div><div><h3>Conclusions</h3><div>Our original 3D RCSA calculation method was associated to intra-operative surgical outcomes. As compared to PADUA and RENAL score, our calculated RCSA represented a more reliable predictor of intra-operative parameters.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Pages 192.e11-192.e19"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concomitant antihistamine administration is associated with improved survival outcomes in patients with locally advanced or metastatic urothelial carcinoma treated with atezolizumab. Analysis of individual participant data from IMvigor210 and IMvigor211","authors":"Giuseppe Fallara M.D. ,&nbsp;Federico Belladelli M.D. ,&nbsp;Daniele Robesti M.D. ,&nbsp;Bernard Malavaud M.D., Ph.D. ,&nbsp;Côme Tholomier M.D. ,&nbsp;Sharada Mokkapati Ph.D. ,&nbsp;Francesco Montorsi M.D. ,&nbsp;Colin P. Dinney M.D. ,&nbsp;Pavlos Msaouel M.D., Ph.D. ,&nbsp;Alberto Martini M.D.","doi":"10.1016/j.urolonc.2024.12.267","DOIUrl":"10.1016/j.urolonc.2024.12.267","url":null,"abstract":"<div><h3>Objectives</h3><div>Survival outcomes of patients with metastatic urothelial carcinoma (mUC) are still suboptimal and strategies to enhance response to immune-oncology (IO) compounds are under scrutiny. In preclinical studies, it has been demonstrated that antihistamines may reverse macrophage immunosuppression, reactivate T cell cytotoxicity, and enhance the immunotherapy response. We aimed to evaluate the role of concomitant antihistamines administration on oncological outcomes among patients with mUC.</div></div><div><h3>Materials and Methods</h3><div>We relied on individual patient data from IMvigor210 (phase II single-arm trial on second line atezolizumab for mUC) and IMvigor211 trials (phase III randomized trial on second line atezolizumab vs chemotherapy for mUC). Among individuals treated with IO we identified patients who did and did not receive antihistamines. Multivariable Cox or competing-risks regression models were used to predict progression-free survival (PFS), overall survival (OS), and cancer-specific survival (CSS). The impact of antihistamines on the outcomes was assessed after adjusting for potential confounders.</div></div><div><h3>Results</h3><div>Among 896 patients with locally advanced or metastatic urothelial cancer who had progressed after first-line chemotherapy, 155 (17 %) received antihistamines during the delivery of IO. Patients receiving antihistamines had longer OS (Hazard Ratio [HR]:0.59; 95 % Confidence interval [CI]: 0.47-0.74; <em>P</em> &lt; 0.001), PFS (HR:0.70; 95 %CI: 0.57-0.87; <em>P</em> = 0.001) and CSS [sHR:0.58; 95 %CI:0.45-0.75; <em>P</em> &lt; 0.001)] relative to those who had not used antihistamine drugs. A sensitivity analysis, after the exclusion of patients who experienced adverse events and received antihistamines, yielded similar findings of prolonged CSS (sHR 0.78; 95 %CI: 0.59-0.98, <em>P</em> = 0.031) and OS (HR 0.71; 95 %CI: 0.52-0.94, <em>P</em> = 0.021).</div></div><div><h3>Conclusions</h3><div>Concomitant antihistamines administration was associated with improved OS, CSS, and PFS in patients receiving atezolizumab as second line treatment for mUC. Further mechanistic and clinical investigation is warranted to elucidate the role of antihistamines in IO.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Pages 188.e9-188.e17"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IMPROVING GERMLINE TESTING IN AT-RISK PATIENTS WITH PROSTATE CANCER","authors":"Juan Javier-DesLoges MD,&nbsp;Ana Flores Pimentel,&nbsp;Yu-Wei Chen MD,&nbsp;Yasoda Satpathy,&nbsp;James Michael Randall MD,&nbsp;Christopher Kane MD,&nbsp;Lisa Madlensky PhD,&nbsp;Matthew Savage PhD,&nbsp;Samuel Pena,&nbsp;Tyler Stewart MD,&nbsp;Aditya Bagrodia MD,&nbsp;Rana McKay MD","doi":"10.1016/j.urolonc.2024.12.074","DOIUrl":"10.1016/j.urolonc.2024.12.074","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Germline testing is recommended for patients with high risk localized, locally advanced, and metastatic prostate cancer. Despite this recommendation, implementation of germline testing in prostate cancer has been suboptimal. There is a need for novel strategies to engage oncology clinicians and patients in germline testing and integrate germline testing into the clinic.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We designed a single-arm investigator-initiated study utilizing video education as a means of delivering pre-test counseling to patients who meet the National Cancer Comprehensive Network testing criteria for germline testing. Inclusion criteria includes men greater than or equal to 18 years of age, diagnosis of prostate cancer of any histology, and NCCN indication for germline testing. Patients who consented to the study underwent a one-on-one in-person education session with an educational video about germline testing. Patients completed pre and post-intervention questionnaires to assess their knowledge and satisfaction with the intervention. The primary endpoint was the proportion of patients who underwent germline testing among those enrolled to the study. Key secondary endpoints include the impact of education intervention on change in knowledge of germline testing and patient perceptions of germline testing.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The study enrolled a total of 58 patients, 50 patients completed the study protocol. The majority of patients were White 78.0% (39/50), Non-Hispanic 92.0% (46/50), spoke English 98.0% (49/50), and were college educated 70% (35/50). The majority of patients had high risk localized disease 46.0% (23/50) or metastatic castrate sensitive prostate cancer 26.0% (13/5). Overall, 82.0% (41/50) of patients choose to participate in germline testing following the intervention. Of the tests ordered, 26.0% (13/50) were by urologists and 74.0% (37/50) were by medical oncologists. In this cohort 12.0% (6/50) of patients had a P/LP mutation, 14.0% (7/50) had a VUS. The most important factor influencing patients to pursue genetic testing would be if the results guide treatment selection. The most important factor influencing patients to not pursue genetic testing would be if the results had no clinical value. Most patients had a high level of understanding of genetics knowledge prior to the intervention with a mean score of 9.1 out of 11 in the genetics knowledge test. There was no significant increase or decrease genetics knowledge after the intervention (p = 0.88). A majority of patients were satisfied with the intervention and found it useful 94% (47/50).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The uptake of germline testing after the video intervention was high, most patients already had an understanding of genetics, but were more likely to pursue testing after the intervention and if it would influence their treatment. Furthermore, utilization of virtual educational aids should ","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 29"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}